Abstract：
OBJECTIVE: To explore prognostic multimarker models for progression to macular fibrosis (MF) over 24 months specific to type 3 macular neovascularisation (T3 MNV).
METHODS: This retrospective, exploratory, single-centre, cohort study comprised 65 eyes of 43 Caucasian patients with treatment naive T3 MNV, all with a 24-month follow-up post anti-VEGF therapy using a strict pro-re-nata (PRN) regimen. Data on demographic features, clinical findings, frequency of intravitreal treatments and optical coherence tomography biomarkers were collected at baseline and after 12 and 24 months of follow-up. Logistic regression models (LRM) and receiver-operating curve (C-index) analyses were performed to evaluate the prognostic ability of the studied biomarkers in discriminating between MF affected and unaffected patients.
RESULTS: At final follow-up, MF was present in 46.2% of eyes. Subretinal hyper-reflective material (SHRM) and subretinal pigment epithelium multilaminar hyper-reflectivity (multilaminae) emerged as significant predictors for MF, with adjusted odds ratios (OR) of 18.0 (95% CL 13.4 to 24.1) and 11.8 (95% CL 8.66 to 16.0), respectively. Additionally, the presence of multifocal lesions (OR 0.04, 95% CL 0.01 to 0.30) appeared to decrease the likelihood of MF. C-indexes for the selected LRMs ranged between 0.92 and 0.88, indicating a comparably high discriminant ability. Despite consistent treatment schedules between the two groups (MF: median intravitreal treatment (IVT) number=10.5, IQR=7; non-MF: median IVT=10, IQR=6), a decline in best-corrected visual acuity was noted in the group with MF onset over the 24-month follow-up (-13.0 ETDRS letters; 95% CL -22.1 to -3.9; p=0.006).
CONCLUSIONS: Our study identifies SHRM and multilaminae as relevant predictors of 24-month onset of MF in patients with T3 MNV. These findings enrich our understanding of the development of MF in T3 MNV and can guide improved risk prognostication. Future research should consider larger samples and prospective designs to validate these predictors.
METHODS: This retrospective, exploratory, single-centre, cohort study comprised 65 eyes of 43 Caucasian patients with treatment naive T3 MNV, all with a 24-month follow-up post anti-VEGF therapy using a strict pro-re-nata (PRN) regimen. Data on demographic features, clinical findings, frequency of intravitreal treatments and optical coherence tomography biomarkers were collected at baseline and after 12 and 24 months of follow-up. Logistic regression models (LRM) and receiver-operating curve (C-index) analyses were performed to evaluate the prognostic ability of the studied biomarkers in discriminating between MF affected and unaffected patients.
RESULTS: At final follow-up, MF was present in 46.2% of eyes. Subretinal hyper-reflective material (SHRM) and subretinal pigment epithelium multilaminar hyper-reflectivity (multilaminae) emerged as significant predictors for MF, with adjusted odds ratios (OR) of 18.0 (95% CL 13.4 to 24.1) and 11.8 (95% CL 8.66 to 16.0), respectively. Additionally, the presence of multifocal lesions (OR 0.04, 95% CL 0.01 to 0.30) appeared to decrease the likelihood of MF. C-indexes for the selected LRMs ranged between 0.92 and 0.88, indicating a comparably high discriminant ability. Despite consistent treatment schedules between the two groups (MF: median intravitreal treatment (IVT) number=10.5, IQR=7; non-MF: median IVT=10, IQR=6), a decline in best-corrected visual acuity was noted in the group with MF onset over the 24-month follow-up (-13.0 ETDRS letters; 95% CL -22.1 to -3.9; p=0.006).
CONCLUSIONS: Our study identifies SHRM and multilaminae as relevant predictors of 24-month onset of MF in patients with T3 MNV. These findings enrich our understanding of the development of MF in T3 MNV and can guide improved risk prognostication. Future research should consider larger samples and prospective designs to validate these predictors.
摘要：
目的：探讨3型黄斑新生血管（T3MNV）的24个月内进展为黄斑纤维化（MF）的预后多指标模型。
方法：本回顾性研究，探索性,单中心,队列研究包括43例白种人患者的65只眼，接受幼稚T3MNV治疗，所有患者均在使用严格的pro-rena-nata（PRN）方案的抗VEGF治疗后进行24个月的随访。人口统计特征数据，临床发现，我们在基线时以及随访12个月和24个月后收集了玻璃体内治疗的频率和光学相干断层扫描生物标志物.进行了Logistic回归模型（LRM）和受试者工作曲线（C指数）分析，以评估所研究的生物标志物在区分MF受影响和未受影响的患者中的预后能力。
结果：在最后的随访中，MF存在于46.2%的眼睛中。视网膜下高反射材料（SHRM）和视网膜下色素上皮多层高反射率（多层）是MF的重要预测因子，调整后的赔率比(OR)为18.0(95%CL13.4至24.1)和11.8(95%CL8.66至16.0)，分别。此外,多灶性病变的存在(OR0.04,95%CL0.01~0.30)似乎降低了MF的可能性.所选LRM的C指数介于0.92和0.88之间，表明判别能力相当高。尽管两组之间的治疗方案一致（MF：中位玻璃体内治疗（IVT）数量=10.5，IQR=7；非MF：中位IVT=10，IQR=6），在24个月随访期间,MF发作组的最佳矫正视力下降(-13.0ETDRS字母;95%CL-22.1~-3.9;p=0.006).
结论：我们的研究确定SHRM和多层膜是T3MNV患者24个月MF发作的相关预测因子。这些发现丰富了我们对T3MNV中MF发展的理解，并可以指导改善的风险预测。未来的研究应该考虑更大的样本和前瞻性设计来验证这些预测因子。
方法：本回顾性研究，探索性,单中心,队列研究包括43例白种人患者的65只眼，接受幼稚T3MNV治疗，所有患者均在使用严格的pro-rena-nata（PRN）方案的抗VEGF治疗后进行24个月的随访。人口统计特征数据，临床发现，我们在基线时以及随访12个月和24个月后收集了玻璃体内治疗的频率和光学相干断层扫描生物标志物.进行了Logistic回归模型（LRM）和受试者工作曲线（C指数）分析，以评估所研究的生物标志物在区分MF受影响和未受影响的患者中的预后能力。
结果：在最后的随访中，MF存在于46.2%的眼睛中。视网膜下高反射材料（SHRM）和视网膜下色素上皮多层高反射率（多层）是MF的重要预测因子，调整后的赔率比(OR)为18.0(95%CL13.4至24.1)和11.8(95%CL8.66至16.0)，分别。此外,多灶性病变的存在(OR0.04,95%CL0.01~0.30)似乎降低了MF的可能性.所选LRM的C指数介于0.92和0.88之间，表明判别能力相当高。尽管两组之间的治疗方案一致（MF：中位玻璃体内治疗（IVT）数量=10.5，IQR=7；非MF：中位IVT=10，IQR=6），在24个月随访期间,MF发作组的最佳矫正视力下降(-13.0ETDRS字母;95%CL-22.1~-3.9;p=0.006).
结论：我们的研究确定SHRM和多层膜是T3MNV患者24个月MF发作的相关预测因子。这些发现丰富了我们对T3MNV中MF发展的理解，并可以指导改善的风险预测。未来的研究应该考虑更大的样本和前瞻性设计来验证这些预测因子。
